Nokea
A client taking which of the following medications will see a decrease in effectiveness if rivastigmine (Exclon) is initiated?
- A. Benztropine (Cogentin)
- B. Quetiapine (Seroquel)
- C. Glycopyrrolate (Robinul)
- D. Theophylline (Theo-Dur)
- E. Tiotropium (Spiriva)
Correct Answer: A,C,E
Rationale: A client taking anticholinergic medications, like benztropine, glycopyrrolate, and tiotropium, will see a decrease in effectiveness if rivastigmine (Exelon) is initiated.
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A nurse should advise clients taking which medications to avoid the use of ginkgo?
- A. Selective serotonin reuptake inhibitors
- B. Monoamine oxidase inhibitors
- C. NSAIDs
- D. Nonsalicylates
- E. Anticholinergics
Correct Answer: A,B
Rationale: Ginkgo is contraindicated in clients taking SSRI or MAOI antidepressants, because of the risk of a toxic reaction. Cholinesterase inhibitors interact with anticholinergics. Ginkgo does not interact with NSAIDs or nonsalicylates.
After teaching a group of nursing students about confusion and how it differs from dementia, the instructor determines that the teaching was successful when the students identify which of the following about delirium?
- A. The onset occurred suddenly.
- B. Memory is significantly impaired.
- C. Sensory impairment occurs.
- D. Environmental changes are needed for safety.
Correct Answer: A,C
Rationale: Delirium occurs suddenly, affects the senses, and is reversible when the cause is found. In contrast, dementia occurs slowly, affects memory and judgment, and is not reversible, often requiring a change in the environment to maintain safety.
A client asks the nurse about using the herb ginkgo to improve his memory and thinking. Which of the following would the nurse need to integrate into the response about this herb?
- A. There is scientific proof that this herb is effective.
- B. The effects may take at a minimum 4 weeks to occur.
- C. Mild GI discomfort and headache may occur with the herb.
- D. The herb needs to be taken at least four times a day to be effective.
- E. The herb if taken in large doses rarely leads to problems.
Correct Answer: B,C
Rationale: Conflicting research both supports and disputes ginkgo's ability to enhance memory. The effects of ginkgo may not be evident until after 4 to 24 weeks of treatment. The most common adverse reactions include mild GI discomfort, headache, and rash.
A client is prescribed donepezil for dementia. Review of the client's medication history reveals that the client uses NSAIDs for arthritis. The nurse would assess the client closely for which of the following?
- A. Decreased effectiveness of the NSAID
- B. Increased risk of NSAID toxicity
- C. Increased risk of GI bleeding
- D. Decrease GI absorption of the donepezil
Correct Answer: C
Rationale: NSAIDs in conjunction with donepezil increase the client's risk for GI bleeding. The effectiveness of the NSAID does not decrease, nor does the GI absorption of donepezil. There is no increase in the risk for NSAID toxicity.
A client is receiving donepezil. When reviewing the client's medication history, the nurse determines that the client is at increased risk for GI bleeding if the client is also taking which drug?
- A. Naproxen (Naprosyn)
- B. Oxycodone (OxyContin)
- C. Acetaminophen (Tylenol)
- D. Ibuprofen (Motrin)
- E. Meperidine (Demerol)
Correct Answer: A,D
Rationale: Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, in combination with donepezil place the client at an increased risk for GI bleeding. Oxycodone, acetaminophen, and meperidine do not increase the client's risk.